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2-Step BP
How to manually measure Blood Pressure
| Step | Detail |
|---|---|
| Step 1 | To find a baseline systolic reading, determine which arm the patient wants to use |
| Step 2 | Position the patient with arm supported at heart level, legs uncrossed, and feet flat on the floor |
| Step 3 | ***Measure to find appropriate cuff size – 40% of the circumference of upper arm covered by the cuff width-wise, and two-thirds length of the upper arm covered when wrapped. |
| Step 4 | ***Palpate brachial artery (to locate) |
| Step 5 | ***Squeeze excess air from cuff and center the cuff bladder over the brachial artery at one inch above antecubital space |
| Step 6 | ***Wrap deflated cuff snugly and evenly over exposed upper arm – no clothing on the arm |
| Step 7 | Position the manometer at eye level |
| Step 8 | ***Palpate the radial artery with fingertips of the non-dominant hand and slowly inflate until the pulse disappears. Note the number where pulse disappears! Continue to inflate by 30mm Hg above where the pulse disappeared. EX: 116 to 146 |
| Step 9 | ***Deflate the cuff at 2-3mm Hg per second while feeling for the pulse’ return. Note the number where pulse returns! The number reading for appearance should be the same as disappearance. If numbers differ, use the higher number. EX: 116 to 118, use 118 |
| Step 10 | ***Now that the baseline systolic pressure is found, deflate the cuff fully and wait 30 seconds before measuring the BP reading |
| Step 11 | ***Place the stethoscope ear pieces in your ears (pointed towards the nose to follow the angle of the ear canal) and place the diaphragm over the brachial artery |
| Step 12 | ***Close the pump valve and inflate the cuff to 30mm Hg over the established palpated systolic reading. The first sound heard is the systolic number |
| Step 13 | ***Gradually deflate the cuff at a constant rate of 2-3 mm Hg per second, to 30 mm Hg past the last sound heard. The very last sound heard is the diastolic number |
| Step 14 | If unable to get an accurate reading, rapidly and fully deflate the cuff and wait 30 seconds before trying again |
| Step 15 | Remove the cuff from the patient |
| Step 16 | ***Accurately identify blood pressure reading within 6 mm Hg of monitor to pass |
| Step 17 | Perform hand hygiene |
| Step 18 | Document procedure in patient chart |
Created by:
MrsLaceUp
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